'Safe staffing' order for Trusts

Hospital bosses are to be forced to set safe staffing levels on wards in a bid to prevent another care crisis similar to the one at Stafford Hospital.

From next April, each hospital trust will have to publish staffing levels on a ward-by-ward basis, including the percentage of shifts that meet safe staff levels, the Department of Health (DH) said.

And trust boards will have to publicly examine staffing levels, a spokeswoman said.

The move forms part of the Government's formal response to the Mid Staffordshire NHS Foundation Trust Public Inquiry.

The inquiry, chaired by Robert Francis QC, highlighted the "appalling and unnecessary suffering" of hundreds of people at Stafford Hospital between 2005 and 2009.

Up to 1,200 patients may have died needlessly after they were "routinely neglected" at the hospital. Many were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.

Mr Francis made a total of 290 sweeping recommendations for healthcare regulators, providers and the Government.

One of the key suggestions was that the National Institute for Health and Care Excellence (Nice) should set out how many staff are needed on any type of ward at any time.

While the Government's response to the inquiry does not call for safe staffing levels to be set at a national level, it does call on hospital boards to set levels locally using guidance issued by NHS England's chief nurse that tells them what safe staffing looks like, a DH spokeswoman said.

She said that Nice will create guidance on the matter at a later date but will not suggest minimum staff to patient ratios.

The Care Quality Commission will inspect trusts and make sure they have the right numbers of staff, she added.

Patients will be able to see their hospital's staffing levels on a new patient safety website. The new national safety website will include data on staffing numbers and other safety indicators including information on the number of "never events" - events that should never happen in the health service such as a surgeon operating on the wrong part of the body or leaving medical kit inside of a patient.

And NHS England is to appoint 5,000 "patient safety fellows" who will be champions in patient safety, she added.

Jane Cummings, NHS England's chief nursing officer, said: "We have a very clear evidence of a link between appropriate staffing and the outcomes of our patients. This evidence must be used to set staffing levels locally.

"Patients and the public are therefore entitled to know that we have the right number of people in place to provide safe, quality care every time.

"We first encouraged a move towards greater transparency on staffing levels in my nursing strategy, but we are now going further. Hospitals will have to publish this information - at ward level - and present the evidence they have used to determine staffing levels in public.

"That is the right way to ensure there is rigour around decisions that are taken, as well as to provide hospitals and other services with the flexibility they need to get the right staff in the right place. We need the right level of staffing in every locality - and that cannot be mandated centrally."

The news comes as Health Education England reported that NHS hospitals are planning to recruit 3,700 more nurses by the end of the financial year.

Health Minister Norman Lamb said: "We are determined to see the NHS become a world leader in patient safety - with a safety ethos and level of transparency that matches the airline industry. The Francis report is already having an effect, with the NHS planning to hire more than 3,700 extra nurses over coming months.

"Experts know that the right number of staff varies by ward and by shift, and should be based on evidence. We need transparency on staffing levels, backed up by a strong inspection regime to get better, safer care".

The Government's initial response to the Francis inquiry saw the introduction of Oftsed-style ratings for hospitals handed out by a new Chief Inspector of Hospitals. Health Secretary Jeremy Hunt also announced there would be a national black list of failing hospital bosses and proposed a "statutory duty of candour" for NHS providers so patients are fully informed when something goes wrong with their care.

Ministers also commissioned Professor Don Berwick, former healthcare advisor to president Barack Obama, to perform a review of safety in the health service.

Prof Berwick said: "The best keys to health care safety do not lie in blame, regulation, or punishment, but rather in learning, support, and encouragement to the health care staff, the vast majority of whom are dedicated to excellence in care.

"Leaders who aim for safe and effective care have a duty to supply the workforce with the tools, knowledge, and encouragement to do the work that adds meaning to their lives."

Labour's shadow health secretary Andy Burnham said: "There are today close to 6,000 fewer nurses in the NHS than when this Government came to power. As a result, too many hospitals in England do not have safe staffing levels.

"We have repeatedly warned the Government about nurse numbers falling to dangerous levels. This new focus on recruitment is overdue but it shouldn't have taken this long and it won't be enough to repair the damage of three years of falling nurse numbers on David Cameron's watch. He is allowing the NHS to go into a dangerous winter with a shortage of nurses and with increasing numbers of older people being admitted because of this Government's deep cuts in social care."